CLINICAL NURSING JUDGEMENT 1

The True Importance of Clinical Nursing Judgement

Alayna M O’Rourke

Youngstown State University, Nursing Department

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Abstract

Clinical judgment in nursing is an essential process and skill that is essential to providing quality

nursing care. Clinical judgement and clinical competence allow nurses to ensure delivery of

quality, safe, and correct nursing care. The process of developing clinical judgement and clinical

competence is learned over a period of time through clinical experience, simulation experience,

and educational lectures. While expert and experienced nurses make clinical judgements and

decisions within seconds of collecting their data, novice nurses and nursing students struggle to

make sound clinical decisions. Over time, the development of clinical judgment and sound

clinical competence is developed through experience and the gain of confidence. Eventually,

leading to the nurse’s ability to promote patient health and recognize changing circumstances

requiring appropriate action.

Keywords: Clinical judgment, clinical competence

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The True Importance of Clinical Nursing Judgement

Clinical judgment is the process by which a nurse collects data regarding their patient,

interprets the data collected, using the interpretation to arrive upon an appropriate nursing

diagnosis, incorporating nursing interventions related to the diagnosis, interpreting the

effectiveness of the interventions, and finally deciding whether the interventions should be

continued or modified to the patients developing condition. This process requires effective

problem-solving skills, competent decision-making abilities, and critical thinking skills. Clinical

nursing judgment will involve the nurse to progress through the appropriate steps and decide

appropriate act to be taken, or to not act at all. Novice nurses and nursing students typically do

not possess enough clinical experience or competence to make appropriate decisions quickly

following their data collection. Over time, unexperienced nurses will gain the needed experience

to aid in their development of important interpretation and judgement skills.

Clinical judgment is commonly defined as the informed opinion (using intuition,

reflection, and critical thinking) that relates observation and assessment of patients to identifying

and evaluating alternative nursing options (Standing 2017). In other words, clinical judgment

involves assessing the potential risks and benefits of possible alternative actions before

committing to a specific decision. Decision-making links judgement to practice by acting on

available options to evoke to best possible patient outcome. Clinical nursing judgement and

decision making are made through evidence ranging from observations to chart review, although

different aspects of decision making are influenced by problem and time available (Standing

2017). In emergency situations nurses rely heavily on intuitive judgment and observation of the

patient. Whereas in situations allowing for more time to make clinical decisions, nurses need to

make critical informed judgement. In the two different situations, especially emergencies, novice
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nurses struggle to make appropriate decisions due to their lack of experience and clinical

competence. Because of this, patient’s well-being can be put into jeopardy without the oversight

of experienced nurses in critical situations. Over time novice nurses will develop critical

experience and competence, evoking the confidence to make sound judgement skills to benefit

their patient in ordinary or emergency situations.

Clinical judgment is essential to delivering high quality nursing care. Therefore, it is the

moral obligation of professional nurses to strive for expert clinical judgement in an effort to

provide the best patient care possible (Manetti 2015). Each day nurses are faced with making a

multitude of decisions in their practices, each decision unique to each problem. Because of the

multitude of problems demanding the nurse’s attention it is essential to prioritize, delegate, and

make decisions influencing positive patient outcomes. The clinical judgement skills needed to

make these decisions is detrimental to the nurses’ ability to prioritize patient needs and nursing

responses, while continually assessing and evaluating outcomes that may require a revised

approach to manage arising problems (Manetti 2015). Most novice nurses and nursing students

lack the clinical judgement skills needed to make quick decision regarding knowing when to act

and to not act. Which is such an important factor when preventing patient injury and a decline in

patient health status. The field of nursing has been trying to define, teach, and measure clinical

judgment for many years, constantly researching the subject and improving the educational

aspects. Nursing clinical judgment is a difficult task to master, because of this novice nurses

along with experienced nurses need to continually educate themselves to promote the best

clinical judgment and competent decisions for the good of the patients.

Nurses are significant decision makers in any health care system, exercising their clinical

judgment before making choices with, for, and on behalf of their patients (Thompson 2013).
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Nurses have a key role to play in the health care system and patient care, requiring effective

clinical judgment and decision making to contribute to the quality of the health care system and

the care being provided. Because of this, it is detrimental to constantly work to improve nurses’

judgments and decisions to help improve the quality of patient care (Thompson 2013). With

nurses being the biggest advocates for not only the nursing profession but their patients, it is

important for clinical judgment skills to be developed quickly and properly. Although there are

constant changes occurring in the health care field, one thing that will never change is the need

that patients will have for their nurses during their time of need. Patients, weather inpatient or

outpatient, rely on their nurse’s clinical judgment to improve their health and safety. Clinical

judgment plays a role in all aspects of nursing and the competent care provided by nurses.

Personally, I have witnessed clinical nursing judgment being practiced during all clinical

experiences. Without even noticing, I have seen nurses use clinical judgment to implement new

interventions for patients in ordinary and emergent situations. I have personally noticed my

improvement of clinical judgment in ordinary and emergent situation that I have been presented

with in the small amount of time I have spent precepting. A specific situation that proved to me

that I was developing competent clinical judgment was when a patient arrived to my preceptor

and I via ambulance is obvious respiratory distress. He was using assessory muscles to breath, he

was cyanotic around his mouth and finger nails, his saturation was only 68% on 15L

nonrebreather, and he was unable to talk due to the extensiveness of his shortness of breath,

which immediately presenting the problem of not knowing his identity or history. We quickly

recognized that this was an emergent situation, so my preceptor looked at me and asked what I

wanted to do. Without stopping to think about it, I instantly told him we needed to alert the ER

physician and auscultate his lung sounds. We immediately found he had absent breath sounds on
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his right side, indicating either a pneumothorax or a pulmonary embolism. After a STAT chest x-

ray, it was known his entire right lung was collapsed and an emergent chest tube insertion was

required to save this man’s life. When things finally slowed down, and the patient’s status

improved greatly. It was determined he was a pack a day smoker with COPD leading to a

spontaneous pneumothorax. The patient was faced with a life-threatening condition, and I was

able to use quick clinical judgment with the knowledge I possessed. This proved to me that even

as a nursing student, I had enough knowledge to make critical judgment and decisions. This gave

me so much more confidence in the knowledge I possess. I know over time my skills and

knowledge will continue to grow and improve, along with my personal confidence towards my

clinical skills.

Strong clinical judgment is a skill that is development with experience and time. It is a

skill that can be mastered, but also requires constant improvement from novice and experienced

nurses. Clinical judgment and competence give nurse’s the ability to promote patient health and

recognize changing circumstances requiring appropriate action. With each experience, nurses

will learn and grow allowing for the constant molding of their clinical judgment, decision

making skills, and care provided to their patients.

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References

Manetti, W. G. (2015). Clinical judgement in baccalaureate pre-licensure nursing students (Order

No. 3701058). Available from Nursing & Allied Health Database; ProQuest Dissertations &

Thesis A&I.

Standing, M. (2017). Clinical judgement and decision making in nursing(3rd ed.). Los Angeles:

Sage/Learning Matters.

Thompson, C., Aitken, L., Doran, D., & Dowding, D. (2013). An agenda for clinical decision

making and judgement in nursing research and education. International Journal of Nursing

Studies,50(12), 1720-126.